Michael A. Finn, MD Department of Neurosurgery, University of Utah, Salt Lake City, Utah Joel D. MacDonald, MD Department of Neurosurgery, University of Utah, Salt Lake City, Utah Reprint requests: Joel D. MacDonald, MD, Department of Neurosurgery, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT 84132. E-mail: neuropub@hsc.utah.edu Received, October 8, 2009. Accepted, June 5, 2010. Copyright ª 2010 by the Congress of Neurological Surgeons A Population-Based Study of All-Terrain Vehicle-Related Head and Spinal Injuries BACKGROUND: All-terrain vehicles (ATVs) are inherently unstable and their use results in numerous injuries annually in the United States. OBJECTIVE: We evaluated the magnitude of ATV-related head and spinal column injuries in Utah and identified risk factors that might be addressed by preventative measures. METHODS: Four statewide trauma and hospital databases were queried to obtain data on hospital visits by patients with ATV-related neurological injuries in Utah from 2001 to 2005. RESULTS: Seven hundred forty-one patients (median age, 24 years; range, 2-87 years) with ATV-related head and spinal injuries were identified. Five hundred one patients had injuries requiring transport to a hospital, of which 261 required intensive care. Five hundred fifty-nine patients experienced head trauma and 328 patients sustained spinal trauma. The average injury severity score was 12.6 (range, 0-75). Average hospital stay was 4 days (range, 0-34 days). Vehicle rollover was the most common mechanism of injury (28.6%), followed by loss of control and separation of rider and vehicle (20.1%) and collisions with stationary objects (6.1%) or other vehicles (4.1%). Helmet use was in- consistently documented, but patients without helmets were more likely to have a head injury. Injury frequency increased over time, from 116 in 2001 to 174 in 2005. CONCLUSION: The number of ATV-related head and spinal injuries is increasing in Utah. Serious injuries requiring surgery or intensive care are common. Riders under 20 years of age are especially at risk, and helmet use may decrease the likelihood of admission to the intensive care unit, head injuries, and death. KEY WORDS: All-terrain vehicle, Neurological injury, Risk factor Neurosurgery 67:993–997, 2010 DOI: 10.1227/NEU.0b013e3181f209db www.neurosurgery-online.com A ll-terrain vehicles (ATVs) are small 1- or 2-passenger vehicles with 3 or 4 wheels and engines ranging in size from 50 cc to 950 cc displacement. They have no enclosure for the rider(s) and are equipped with wide, deep- tread tires for steep terrain and variable surface conditions such as sand, mud, and snow. ATVs are commonly used for farm and recreational activities in the state of Utah. Because their wheelbase is short relative to the height of the vehicle and rider, they are inherently unstable 1 and are responsible for a significant number of injuries annually in the United States. 2-4 Since their introduction in 1971, numerous legislative and self- imposed manufacturer efforts, including the ban of 3-wheeled designs, engine-size limitations for child-sized vehicles, and op- erator-training programs, have been adopted to promote safer use of these vehicles. There is still no national legislation, however, regarding ATV safety, and the problem continues to grow. Approximately 1117 000 emergency room visits and 495 deaths due to ATV injuries were reported in 2001 nationwide. 2,4 These numbers represent increases of 211% and 159%, respectively, over those values reported in 1993. 5 In the state of Utah, children as young as 8 years of age are allowed to operate ATVs on public lands, and there is no legal helmet requirement. Current research shows an increased risk of ATV-related neurological injury among passengers, children (,16 years old), and riders not wearing helmets. 6,7 Many of these studies have focused entirely on the pediatric population, and there are few data regarding adults. The incidence of adult neurological injury, factors predisposing to such injuries, and the cost to society are therefore lacking. In this study, we analyzed the incidence of ATV-related head and spinal injuries among all patients in Utah. PATIENTS AND METHODS Four statewide databases—the Utah State Trauma Registry (manda- tory), the Utah Emergency Department Database, the Utah Hospital Inpatient Discharge Database, and Utah Death Certificates/Vital ABBREVIATIONS: AIS, Abbreviated Injury Scale; ATV, all-terrain vehicle; GCS, Glasgow Coma Score; ISS, Injury Severity Scale NEUROSURGERY VOLUME 67 | NUMBER 4 | OCTOBER 2010 | 993 RESEARCH—EXPERIMENTAL (HUMAN) Copyright © Congress of Neurological Surgeons. Unauthorized reproduction of this article is prohibited. Downloaded from https://academic.oup.com/neurosurgery/article-abstract/67/4/993/2556833 by guest on 18 June 2020